BIO-ETHICS LECTURE MODULE

MIDTERMS

Course Outcomes:
1. Apply knowledge of physical, social, natural and health sciences and humanities in ethically managing clients, teams and programs
in any health care setting;
2. Utilize ethical principles in managing a group of clients/ nursing service unit/ program in any setting;
3. Apply ethical guidelines and principles in nursing management;
4. Practice nursing in accordance with existing laws, legal, ethical and moral principles;
5. Communicate effectively in speaking, writing and presenting using ethically and culturally-appropriate language to clients and teams;
6. Report and document up-to-date client care accurately and comprehensively in accordance with ethical guidelines;
7. Apply ethical principles of partnership and collaboration to improve delivery of health services;
8. Manage a nursing service unit/health program in any setting in accordance with ethical guidelines;
10. Participate in varied continuing professional ethical development activities;
11. Practices the ethical core values of the Phil. nursing profession;
12. Apply ethical techno-intelligent care systems and processes in managing resources and programs;
13. Display ethical nursing core values in nursing management and leadership.

Course Learning Outcomes:

After completing this course, the would-be nursing professionals should be able to:
1. Explain the need to study bioethics.
2. Describe ethics, biology, bioethics, and health ethics.
3. Summarize the history of bioethics.
4. Describe the characteristics of a person.
5. Compare act of human from human acts.
6. Define knowledge, freedom and conscience.
7. Enumerate and describe the different types of conscience.
8. Relate knowledge, freedom and conscience as a characteristic of a person.
9. Describe the concepts of Kant, Rawl, St. Thomas Aquinas and Ross on ethics.
10. Compare the concepts of Kant, Rawl, St. Thomas Acquinas and Ross on ethics.
11. Explain the different duties as enumerated by Ross.
12. Appreciate the health care profession as a vocation.
13. Describe the stages of a health care provider-client relationship.
14. Describe the qualities of a good health care provider to the client, society and its profession.
15. Enumerate the responsibilities of a health care provider to the client, society and its profession.
16. Define the different virtues of the health care provider.
17. Define the different vices of health care provider.
18. Practice the different virtues of a health care provider.
19. Describe the principle of stewardship, totality, double effect, cooperation, and solidarity.
20. Enumerate the condition necessary for double effect application.
21. Apply basic ethical principles in health care setting.
22. Describe justice, beneficence and non-maleficence.
23. Apply major bioethical principles in health care.
24. Enumerate principles on how equality could be based.
25. Enumerate the components of an informed consent.
26. Enumerate the rights of a patient.
27. Analyze and discuss different bioethical issues.
28. Relate the importance of bioethics to different bioethical issues.

CONTENT TOPIC FOR MIDTERMS

A. The calling of the health care provider
1. The health care profession
2. The client
3. The health care provider
4. Health care provider-client relationship
B. The qualities and responsibilities of a good health care provider to the client, society and its profession
C. Virtues, vices, and habits of health care provider
1. Virtues
2. Vices
3. Habits
a. Types of good habits
b. Types of bad habits
4. Virtues of the health care provider
▪ Fidelity
▪ Honesty
▪ Integrity
▪ Humility
▪ Respect
 ▪ Compassion
▪ Prudence
▪ Courage
5. Vices of the health care
▪ Fraud
▪ Pride
▪ Greed

TOPIC 1

THE HEALTH CARE

PROFESSION
Is a special calling, a service characterized by a trusting and caring relationship which cannot be measured in monetary terms
The relationship is a covenant – a trusted caring service between a healthcare giver who offers help and a dependent patient who
needs and receives it.

A sick individual becomes a patient if: 1. He admits that he is sick

2. That he can no longer take care of himself
And
3. So, he asks for help or aid

What is a Client?
- Term most often used as a synonym for a PATIENT who receives HEALTHCARE in ambulatory CARE setting especially
when health maintenance rather than illness care is the primary service provided.
Sometimes this term is preferred to denote collaborative relationship rather than a hierarchal one.

Who is a HEALTHCARE PROVIDER?

- HEALTHCARE requires more than just a doctor.
- Healthcare at its most basic requires a team of healthcare providers.
- No matter what health issue a client needs two people in the healthcare team.

A HEALTHCARE PROVIDER is an individual that provides preventive, curative or promotional, or rehabilitative healthcare services in a
systematic way to individuals, families or communities.

What is interpersonal relationship?

⚫
Components of interpersonal relationship

⚫ Scientific principles
Specific communication skills

⚫ and strategies
Creative application of self
What is nurse-
patient relationship?
What is the purpose of nurse – patient relations hip?

Requisites for nurse-patient relationship

⚫ Careful thinking
⚫ Sensitiveness
⚫ Energy
⚫ time

Nurses’ roles in nurse-patient relationship

- Care giver
- Counselor
- Educator
- Consultant
 - Researcher

Characteristics of good nurse-patient relationship

⚫ Relationship is therapeutic
⚫ Exist until patent have fulfilled the health care needs
⚫ Nurses’ work is to attain, maintain, and restore the patients’ health
⚫ Patients are satisfied
⚫ Based on nurses’ competent care derived from skills and knowledge

⚫ Provide holistic care

⚫ Patient/client is an active participant
⚫ Nurse uses patients’ knowledge, attitudes, values, and
⚫ thoughts to plan interventions
⚫ Reciprocal relationship influenced by professional and personal characteristics of both parties

Phases of the nurse-patient relationship

⚫ Pre-interaction phase
⚫ Engagement phase
⚫ Active intervention phase
⚫ Termination phase

Pre-interaction phase
During this phase
⚫ Nurse assess the environment in which the nurse meet with patient
⚫ Explain the professional goals and set priorities
⚫ Both parties enter to the relationship with expectations
⚫ Patients develop uncertainties and hesitate to comply with care and treatments
⚫ Patient and nurse become oriented to overall needs and expectations from the relationship

Engagement phase
⚫ Begin to develop the relationship
⚫ Nurse create a supportive environment
⚫ Establish a therapeutic contact with patients
⚫ Nurse introduce herself and the role functions
⚫ Trust and empathy are basic qualities here
⚫ Develop strong bond and feel less anxiety
⚫ Nurse plays the key role with expertise on illness
⚫ Nurse act as a coordinator
⚫ Nurse observe and assess patients
⚫ Develop an impression and validate with patients
⚫ Patients come to know their health issues and feel fear, discomfort, or insecure feelings and expect help
⚫ Nurses realize patients through their body languages and help them
⚫ Therapeutic relationship is well established

Active intervention phase

⚫ The sense of mutuality is developed between nurse and patient
⚫ Discuss conflicting situations deeply
⚫ Nurse and patient work with commitment
⚫ Nurse sort out problems and solve them
⚫ Collaboration and equal participation is seen
⚫ Aware of the differences of rights, roles, and responsibilities.
⚫ Nurse acknowledge the patients’ feelings, show the
genuine interest, and honesty
⚫ Nurse should be congruent
⚫ Nurse convince the patient of equal right to make decision
⚫ Nobody will play dominant or submissive role
⚫ No violation of patients’ rights
⚫ Patients become independent decision makers

Termination phase
⚫ Start at the time of explaining plans
& goals
⚫ Patient should be informed of the
phase at the beginning
⚫ Otherwise patients develop strong feeling of separation at this phase
⚫ Nurse work on education, health
advices preparing discharge plan
Nurse-professional relationship
How?
⚫ Collaboratively
⚫ Cooperatively
⚫ With acceptance and self worth
⚫ With appreciation
⚫ With respect

Barriers for effective professional

Relationship
● Role stress
● Lack of inter professional
understanding
● Autonomy struggle

ROLE STRESS
- The stress arises from role conflict or role confusion
- Role conflict is a situation that you happen to play a role different from what you expected to play
- Role stress occur when you are expected to do than what you can do
- Result in stress and communication is disturbed

Prevention of role stress

- Experienced persons are responsible
- Understand individual capabilities
- Identify the individual weakness
- Assign tasks accordingly
- Kindly and duly respond against inexperienced behaviors or faults

AUTONOMY STRUGGLES
What is autonomy?
- autonomy is one’s ability to be one’s own person
directed by own desires, not imposed by others.
- When this ability is threatened by others autonomy struggles are arose.
- People with higher level of autonomy underestimate others bringing struggles.

Virtues, Vices and habits of the Healthcare Provider

Virtues – Roman word “vir” – man
- Finds meaning in the circle of thinkers, specially moralist and ethicist.
- Virtue is understood as the faculty of the human person to choose what is good against what is deemed to be
bad or evil.

Vices
- In contradiction to habit, a vice is considered an immoral, depraved or degrading act at all members in a given
society.
- Taken to mean a defect, infirmity, fault, iniquity, offense, wickedness, or corruption
- Derived from the Latin word “vitium” which means failing or defect
- If virtue is a habitual execution of a good deed, vice is considered the product of repeated sinful act.
- In this regard, nurses must maintain only those good habits and virtues acts and avoid ones.
- Example:
- Nurses must not sell to patients medicines that are given free of charge by the hospital. They should likewise
avoid encouraging patients to resort to abortions, specifically to women who are having scandalous pregnancies or
encourage lady patients to buy abortive pills since his/her spouse owns a drugstore.

Habits
- Define as constant, easy way of doing things acquired by the repetition of the same act. Literally, the term means
a having and is this light; all that we have is a habit. However, in the evolution of hermeneutics and semantics, the literal
meaning of the word has changed.
- Modern language clarifies the meaning of the term distinction between entitative habits and operative habits.
- Entitative habits are habits of being. They refer to our connatural qualities, like health, strength, or beauty, which
we hardly call habits today.
- Operative habits mean habits of acting. They refer to the tendencies we have developed in ourselves from
repeated acts. It is in latter type of habits where our attention is focused.
- Once operative habits are acquired, it would be very difficult to eradicate them, because they can make the
agent act spontaneously and even automatically.
- Is the agent responsible of actions that flow out of habits? To answer this let us consider the ethical principles of
habits:
• Habits does not destroy voluntariness and actions performed by the force of habit are imputable to man
• If a habit has been acquired involuntarily, like the habit of using profane language during childhood, the
existence of the habits and the acts which proceed unintentionally from it will lack voluntariness and responsibility so
long as the agent remains ignorant of the existence of the habit.
• If an evil habit has been acquired voluntarily, but a positive, constant effort is being made to dispel it, the acts
that proceed from the habits are involuntary; hence, they are not to be imputed.

Types of Habits
1. Good Habits
2. Bad Habits

Virtues of the Healthcare Provider

1. Fidelity
- Latin word “Fidelitas” which means faithfulness. Fidelity and faithfulness are synonymous terms.
- Also means faithfulness and fidelity to one’s obligations, duties, and responsibilities.
- The healthcare provider is called to exercise fidelity as he/she faithfulness does his/her obligations, duties and
responsibilities.
- In the nightingale pledge, the virtue of fidelity of the healthcare provider, especially the nurse’s, to his/her
profession means his/her unfailing fulfillment of his/her obligations, duties and responsibilities as are firmly emboldened
in his/her vow to practice the craft and vocation of the healthcare profession.
- In trying to apply this in the nursing profession, Helen Keller, all healthcare professionals to stick to fidelity as
they serve the needs of their patients as such as is the very purpose why they became healthcare providers. Only with
fidelity can healthcare professionals assert their worth as professionals in caring for the sick and the infirmed.

2. Honesty
- Latin word “honestus” which means honor.
- Literally, refers to people who are holding honorable or respectable position.
- In this light, the healthcare provider is reminded to practice his/her profession itself as an sphere of honesty in as
much as the healthcare profession itself is an honorable and a respectable career. It is itself an honor on the part of the
nurse to take care of those who are relegated under his/her care.
- The healthcare provider must pursue honesty. He/she is supposed to be sincere, truthful, straightforward,
decent, honorable, creditable and of good moral character.
- He/she should not cheat on his/her patients nor steal anything from them. When the healthcare practices
honesty in his/her profession, the nursing profession reaps merit and glory since honesty is good for the wellness of the
sick.
- On the contrary, a healthcare provider who is liar will add more injury to the illness suffered by the patient. It can
be said that truth has a curative value while lie is fatal and acidic. This explains why Jesus Christ aid that truth will set as
free.
- As the healthcare provider wrestles to be honest, he/she must be loyal to the patient. When it comes to giving
information to the patients relative to the latter’s diagnosis and prognosis, the nurse must strive hard to tell the truth in
a way that is not disastrous to the patient. As the saying goes: “There are many ways of killing a dog.”

3. Integrity
- Integrity comes from Latin word enteros which means whole. It is integrity that can make human person whole
or complete. An honest person is one who can distinctly discern the variance between right and wrong, or one whom is
determined to act on a right decision. Integritas, meaning soundness, is another Latin word through which the term
integrity can be traced. The word integritas is itself derived from another Latin word, integer, which means whole or
complete. Based on the words enteros, integritas, and integer, integrity corresponds to wholeness.
- Applied in the healthcare profession, when can a healthcare professional practice integrity? The healthcare
provider practices integrity when he/she does his/her duties and obligations as a healthcare provider according to the
beliefs, principles, and values he/she claims to embrace or cherish. Hence, a healthcare provider who practices integrity
brushes away hypocrisy since he/she willfully adheres to the ethical code of the profession he/she is practicing.
4. Humility
- As the nurse lives with fedility, honesty, and integrity, he/she is at the same time summoned to practice humility.
Humility does not mean that one has to think less of himself/herself; rather, it invites one to think of himself/herself less.
When one is drunk with all his/her capabilities, achievements, and success, he/she can hardly be humble. Only when one
can readily restrain his/her proven talents, abilities, skills, and achievements, only then can one openly welcome
humility.
- Accordingly, G.K. Chesterton, once shared his views of the meaning of humility in Orthodoxy: “Humility was
largely meant as the restraint upon the arrogance and infinity of the of the appetite”
- Based on the above presentation, a humble healthcare provider is one who ceases to think of his/her own needs
as he/she transcends his/her attention to the needs of the patients. He/she is attentive to the well-being and welfare of
his/her patients. Only through humility can the healthcare provider stop to think more of himself/herself since he/she
will start more of the wellness of his/her patients.
5. Respect
- In many instances, respect is paired with fear, giving raise to questions like “are you afraid of the person that is
why you respect him or do you have respect for the person that is why you are afraid of him?”
- Which is better, to be feared or to be respected? On the part of the healthcare provider, being feared by the
patients will be render useless the purpose of nursing. The healthcare provider must earn the respect of his/her patients
for him/her to become a strong catalyst for the healing process of the patient.
- Respect has a very modest and a bit feminine texture as it is understood as caring for and being concerned about
the feelings of others. Respect can likewise be an act through which one takes notice of others. It also means to regard
others with special attention, esteem, and care, or to consider others worthy of esteem and honor. These meanings of
respect fit the profession of the healthcare provider who is tasked to care for the sick. In the absence of respect, illness
will never be conquered as the spirit of care will be tainted by selfishness, arrogance, and malice.
- It is not true, however, that only the nurses are duty-bound to pay respects to their patients. The patients, as
well, are duty-bound to show respect to the healthcare providers. They can do this by being cooperative and diligent in
their participation to the healing process. Respect may not be a cinch on the part of healthcare professionals especially if
their patients are arrogant and unruly. But, just the same, the exercise of respect is intrinsically expected from the
healthcare provider in line with his/her tour of duty.
- It is very important for the healthcare provider to respect and acknowledge the feelings, beliefs, convictions,
status, and condition of the patient in relation to the latter’s disease and to his/her stature as a human being.

6. Compassion
- Random House Webster’s College Dictionary (2001) defines compassion as “a feeling of deep sympathy and
sorrow for someone struck by misfortune, accompanied by a desire to alleviate the suffering.” The same dictionary takes
compassion as a merciful feeling. Compassion is another appropriate virtue for the nurse as he/she is expected to be
sympathetic to the patient’s distress and suffering. The healthcare provider is expected to be sensitive and to manifest
genuine sorrow for the plight of the patient. He/she ought to show pity and commiseration as he/she witnesses the pain
of the patient. As earlier presented, the patient is always presumed to be vulnerable and weak, which is why he/she
needs the compassionate care of the healthcare provider.
7. Prudence
- Prudence is one of the cardinal virtues according to St. Augustine. It is defined as an exercise of good judgement,
common sense, and caution in the conduct of practical matters. Scholars consider discretion (wise self-restraint),
foresight (ability to see the future or what may happen as a result of one’s decision), forethought (advance rational
calculation of future events), and circumspection (moral considerations as effects of one’s actions). As can be seen,
prudence is the overarching virtue that ties together discretion, foresight, forethought, and circumspection.
- By being prudent, the healthcare provider exercise wisdom, discretion, and carefulness to avoid embarrassing
and distressing situation as he/she fulfills his/her task in the tour of his/her duty.
8. Courage
- Courage is one of the virtues thought by Aristotle. To this great Greek philosopher, courage in the mean (virtue)
between confidence (excess) and fear (deficiency). Courage is as “the quality of mind or spirit that enables a person to
face difficulty, danger, and pain without fear”. It also means confidence, resolution, and conscious self-sacrifice for the
sake of something greater than one’s own self-sacrifice for the sake of something greater than one’s own self-interest.
- Courage is another appropriate virtue for the healthcare provider, especially in the hospital setting, as he/she is
expected to be bold in undertaking a very sensitive job, i.e., to nurse the patient as the latter is engulfed by pain and
suffering. Taking care of the sick requires self-sacrifice and dedication to effect a caring presence, attention, and a
courageous commitment to render healthcare.
- In the absence of courage, the healthcare provider will lose track of the vision and reason of his/her calling.
He/she must not cringe amidst the tragic occurrences in a hospital, such as those that happen in the Operating Room,
Delivery Room, Emergency Room, Intensive Coronary Care Unit, and Intensive Care Unit, among others. Courage keeps
the healthcare provider poised in his/her profession. Courage also allows the healthcare provider to face the challenges
and dangers of the healthcare profession head on.

Vices of the Healthcare Provider

1. Fraud
- False representation of fact, made with a knowledge of its falsehood, or recklessly, without belief in its truth,
with the intention that is should be acted upon by complaining party and actually inducing him to act upon it.
- It is also underrstood as a “deliberate deceit; trickery; an intentional perversion of truth for the purpose of
inducing another in reliance upon it to part with some valuable thing belonging to him, or to surrender a legal right.
- In another case, (Cajucom versus the Philippine Commercial and Industrial Bank) fraud is defined as that which
“connotes serious willingness and deliberate intent on the part of erring party to do wrong or to cause damage to
another”
- In its general sense, fraud “is deemed to comprise anything calculated to concealment involving a breach of legal
or equitable duty, trust or confidence justly reposed, resulting in damage to another”
- The above meaning of fraud, although lifted from jurisprudence, reveal that it “implies a sense of wanton or
deliberate wrongdoing”. Applied in the healthcare profession , it becomes a grave offense on the nurse to deceive, trick
or eventually harm the dignity and health of his/her patient.
- Healthcare providers must understand that fraud is a criminal offense – a crime against public interest. Article
185, 186, 187, 188 & 189 of the revised penal code of the Philippines readily provide the details of the corresponding
penalties of fraud.
- Can easily ensue when a healthcare provider or tampers the medical record of his patient or willfully changes
some data in the latter’s official record.

2. Pride
- Theoretically, pride started in heaven; it is being continued here on earth. And hopefully, it will end in hell. In the
classic catechetical inputs of the Catholic Church, we are told that Lucifer, who eventually became Satan, which
designates not exactly a name but a title meaning deceiver, staged rebellion against God together with the daemons
(Greek word which means angel). What Lucifer did made him the progenitor of one of the seven deadly sins according to
the teachings of the Catholic Faith
- Pride is defined as “feeling of gratification arising from association with something good or laudable” it also
understood as “high or inordinate opinion of one’s dignity, importance , merit, or superiority; conceit; arrogance”
- Further, it is taken to mean “egoism or vanity which implies a favorable view of one’s own appearance,
advantages, achievement and often apply to offensive characteristics”
- Pride leads one to desire and love greatly his/her own excellence. A person drunk with pride always thinks that
he/she is always the best. To him/her, the rest are mere fragments or fractions of his/her achievements.
- Proverbs 29:23 states that “a man’s pride will bring him low, but he is lowly in spirit will obtain honor.
- Pride is the root of all vice/sin and the strongest influence propelling us to sin. This led St. Gregory the great to
opine: “pride, the sovereign of vices, when it is captured and vanguished by the heart, forthwith delivers it into the
hands of its lieutenants, the seven capital vices, that they may despoil it and produce vices of all kinds.
- A healthcare provider who is heavily laden with pride dishonors the healthcare profession. By its very nature,
the healthcare profession calls for humility since the commodity offered is a humble service flavored by the virtues
discussed beforehand in this book. Because of this, a healthcare provider must forget about his/her achievement and
focus on how to help his/her patient come to terms with recovery or well-being.

3. Greed
- Is an excessive desire to wealth or possessions. It’s Latin equivalent is avaritia which means avarice or
covetousness. The Catholic Church qualifies greed as a sin of excess, like lust and gluttony. To this form of vice, St.
Thomas Aquinas remarked “it is a sin against God just as all mortal sins, in as much as man condemns things eternal for
the sake of the temporal things.
- Constructed in the nomenclature of avarice, greed is understood as an utter display of distasteful behaviors, such
as betrayal, bribery, theft, violence and manipulation of authority.
- In the healthcare profession, if a nurse is driven to greed. He/she will become disloyal to his/her patient,
betraying the inherent trust mandated to him/her in the context of nurse-patient relationship. What is worse is that a
greedy healthcare provider might steal or display violence against his/her patients.
- In sum, the triumvirate of fraud, pride and greed are the vices that healthcare provider must willfully avoid.
Otherwise, he/she will destroy the dignity and honor of the healthcare profession.